Purpose：
In NOTES (Natural orifice translumenal endoscopic surgery), the first barrier of the operation in the abdominal cavity is scope orientation. Particularly transgastric NOTES is regarded as a challenging endoscopic procedure because of the unpredictable nature of scope formation and location in the abdominal cavity. These forced situations may result in an incomplete or lengthy procedure within such upside-down and narrow flexible endoscopic viewing. For overcome this limitations, we developed a novel endoscopic navigation system detecting the scope position and scope movement three-dimensionally in the abdominal cavity.
Methods and results：
Survived 13 porcine and canine experiments were included in this study. After a phantom and cadaver experiments, under general anesthesia, we performed NOTES cholecystectomy, gastrojejunostomy, appendectomy, intestinal excision, and hepatectomy in transgastric and transvaginal access. We used a magnetic endoscope observation device, which displayed the shape and position of a flexible endoscope in real time throughout the examination without the use of x-rays. It based on magnetic fields generated by small coils build inside this endoscope and picked up by the built-in antenna of main unit. From this data, the computer reconstructed a schematic picture of endoscope on the display. The utility of this navigation system was evaluated.
Results:
Using a low intensity magnetic field, this magnetic 3-D Imager enabled to display a real-time three-dimensional view of the position and orientation of the endoscope within the abdominal cavity, by means of electromagnetic transmission coils built into the endoscope insertion tube. Shorter procedure time was acquired. All procedures were completed without complications.
Discussions:
This magnetic endoscope navigation system was useful for physicians to see the location and shape of the scope from the outside during an endoscopic examination without the risk of x-ray exposure. In clinical setting, more accurate information should be needed. We developed a new integrating navigation system that virtual 3D anatomy regenerated from MDCT data in DICOM image viewer OsiriX and 3D scope navigation could be superimposed in a monitor screen by detecting the distance between a scope position and skin surface to reveal accurate relations of the patient anatomy and scope orientation using additional magnetic markers outside the body.
Conclusions:
3D NOTES navigation system by magnetic scope detection is useful in safety and improvement of the certainty and operation time by providing a real-time 3D display of endoscope position and configuration.
Session: Podium Presentation
Program Number: S073